The trial phase of spinal cord stimulation implantation for pain relief involves the temporary placement of nerve stimulators, which are small medical devices, in the patient’s body. The device creates nerve signals to interrupt the transmission of pain signals from the spine to the brain, providing effective pain relief. The sensation of pain is transformed into pins and needles or numbness instead. The patient can determine the level of stimulation for different times of the day or adjust the level to accommodate the activity being performed. The device can be controlled with something that is similar to a television remote control. A spinal cord stimulator (SCS) device is surgically placed under your skin and sends a mild electric current to your spinal cord (Fig. 1). Thin wires carry current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the SCS stimulates the nerves in the area where your pain is felt. Pain is reduced because the electrical pulses modify and mask the pain signal from reaching your brain.
To test the temporary spinal cord stimulation device for its effectiveness in relieving pain in patients with chronic pain that do not require surgery.
Spinal cord stimulation can improve overall quality of life and sleep, and reduce the need for pain medicines.
A small percentage of patients may experience complications
After you have been positioned on your stomach on the operating table, the doctor will make a small incision in your back to insert the wire that will disrupt the pain signals into the spinal canal in the area where the pain is felt. The doctor will then use a fluoroscopy machine to check the position of the lead wire as well as ask you about your sensation. Once the wire is placed in the appropriate position, it will be connected to an external stimulator. The wire and stimulator will be attached at the back and stomach of you with waterproof bandages.
Stop any form of blood thinners. Prepare the house/hotel for recovery as there are certain movement limitations like twisting and bending, and you want to ensure you can still function properly without those activities. Since the spinal cord stimulator procedure requires general anesthesia, refrain from eating anything heavy at dinner. Do not eat or drink anything after midnight or the morning of your procedure. Some medications are OK to take in the morning with a sip of water but check with your doctor before doing so. An empty stomach will ensure there will be no complications with the anesthesia while you are under.
Most patients leave the same day as their procedure — once the anesthesia has worn off. For several days after surgery, your incisions may be painful. Try not to stretch, twist or reach, which could pull at the incisions. Dressings will be placed over the incision sites, which can be removed after about 3 days. In most cases, incisions heal within about 2-4 weeks after surgery. Your doctor will discuss your recovery plan, but generally lighter activity is recommended for about 2 weeks after surgery. Once your surgeon approves you for regular activity, you can return to work and drive again (with the stimulator turned off). This is typically 1-2 weeks after surgery.
Complications are rare in this procedure, but all surgery has certain risks, as follows: Possible side effects that can occur, depending on the person and how they respond to the procedure, include: Pain persists because the nerves are not stimulated. Irregular nerve stimulation, providing erratic pain relief. Stimulation of the wrong nerves due to the movement of the lead wire. Stimulation causes discomfort or pain where the lead wire is placed. Problems with the programming or transmission of the device.
How Long Does the Spinal cord stimulation Trial Last?
A spinal cord stimulator trial period is at least 5 to 7 days. This gives you time to test the device and evaluate its effectiveness managing your pain at rest and during activity. While SCS may not completely eliminate your pain, a 50% reduction in pain is considered a successful trial. A growing number of physicians now focus on improved quality of life, not only on the percentage of pain reduction.
What does recovery look like after the procedure?
Approximately 10 days after surgery you will come to the office to have the incision checked. Bring your device remote and product box to your follow-up appointment with the surgeon. Programming of the pulse generator can be adjusted at this time if needed. It is important to work with your doctor to adjust your medications and refine the programming of the stimulator. Your pain specialist and device representative will work with you to fine-tune adjustments to the SCS.
Why is this procedure called a trial?
Before a patient can receive a spinal cord stimulator implant--a permanent implant in the spinal canal--he or she must undergo a spinal cord stimulator trial. The trial phase is extremely important, as it will allow your pain management provider to determine how effective spinal cord stimulation is in relieving your pain. During the trial phase, the epidural space--the outermost area of the spinal canal--is accessed using x-ray guidance and an epidural needle. Once proper placement of the needle has been confirmed, your pain specialist will insert a small electrode through the needle and confirm proper placement in the epidural space. These electrodes are connected to a spinal cord stimulator device that, when activated, sends tiny electrical pulses to the epidural space. After one electrode is successfully placed, the process is repeated to place a second electrode. Placement of two electrodes is typical during the trial phase. After proper placement of the electrodes, a member of the device’s team will activate the spinal cord stimulator and ask you to describe the sensations you experience as he or she adjusts the device’s settings. A successful trial will gradually replace pain sensations with a pleasant tingling feeling, a process which typically takes only 10 minutes. After the initial test of the electrodes, your pain specialist will remove the epidural needle and secure the electrodes to your back with tape and a small number of stitches. Once this is complete, you will leave the clinic and begin a 5-day trial of the device. During the trial, you should continue all daily activities normally. You should also continue to take any prescribed daily pain medications. During this time, pay close attention to your pain levels and how your activity level is affected due to your pain. At the end of the five day trial period, you will return to the pain clinic to have the electrodes removed. You will also talk to your doctor about the effectiveness of the trial in reducing your daily pain. If you experienced at least a fifty percent reduction in pain and were able to complete daily activities more easily, you’re likely a good candidate for a spinal cord stimulator implant.
What happens next if my trial procedure is successful?
If a patient has undergone a successful spinal cord stimulator trial, he or she may elect to receive a permanent implanted device. Permanent implantation of a spinal cord stimulator is a surgical procedure that is performed under general anesthesia in an operating room. The permanent implantation can be done via laminotomy, performed by an outside surgeon, or via percutaneous implant, performed by a pain specialist. It’s important to talk with your doctor about the risks, benefits and potential complications of permanent implantation via laminotomy versus percutaneous implantation.